Growing rural medicine

Seeds take root in a new generation of B.C. doctors

Adrienne Montgomery was working on the Stats Canada Census of Agriculture when she noticed something troubling: the biggest issue affecting rural people was poor access to health care. Montgomery, who holds a UBC agriculture degree, wondered what more she could do to help.

“I walked past a poster one day saying that we need more rural doctors, and I thought: ‘isn’t that interesting?’” says Montgomery. “So I quit my job, moved back to B.C., and applied to medical school.”

Four years later, Montgomery is completing her medical undergraduate training at UBC’s Northern Medical Program (NMP), part of UBC’s unique distributed medical education program that sees doctors take their first term in Vancouver, and the rest of their four years of training at sites around the province.

“Many factors that influence recruitment and retention are in the hands of the government and the health authorities, but we are doing our part to bring more doctors and improve access to care for underserved populations.”

“It was important for me to see how doctors in a small, rural setting connect with the hospital and the community.”

In July, she will return to Terrace, B.C. where she spent her third year in an innovative integrated community clerkship, to begin UBC Family Medicine postgraduate residency training, bringing her one step closer to improving health for people in the North. That final step is key. Becoming a doctor in B.C. requires both undergraduate training, and postgraduate residency in a hospital, caring for patients.

UBC’s undergraduate and postgraduate training programs are placing young doctors, like Montgomery, in communities across B.C., where they can learn first-hand from patients and rural doctors. The evidence shows that as students gain exposure to the people and places, as well as the rewards of practice, they are more likely to set up shop there.

A vision for better medical service in B.C.

That premise was the central pillar behind UBC’s expansion and distribution of medical education, which began in 2004 with the launch of the Northern Medical Program based in Prince George, the Island Medical Program in Victoria, and in 2010, the Southern Medical Program in Kelowna.

Prior to 2004, B.C. was in rough shape. The number of physicians in training had not kept up with a growing population, and many of B.C.’s physicians were in their 50s and quickly approaching retirement.

Over the last ten years, the provincial government and UBC have more than doubled the number of physicians in training. Currently, 288 medical undergraduates enter the program each year, up from 126 in 2003. And there are now 308 entry-level postgraduate residency positions, up from 163 in 2003.

It is still early to assess program success. More than 83 per cent of students that have graduated from the MD undergraduate program since 2008 are still going through their residency, which takes two years for family medicine, or from five to seven years for a specialty.

However, more than 85 graduates have completed their family medicine residency and are now practicing in the province, including 16 in the areas served by the Northern Health Authority.

Dr. Dan Crompton first fell in love with rural medicine while on a second-year rotation in Smithers. After graduating from the NMP in 2008, Crompton completed rural family practice and emergency medicine postgraduate training, and now works as an ER doctor at Prince George’s University Hospital of Northern British Columbia.

“It is great! I learn new things every day. I am able to help people at critical moments in their lives,” says Crompton. “Prince George has a wonderful medical community. They are a talented, dedicated and collegial group of people. Being able to come back and be a part of that community was very attractive. And now, I’m in turn teaching NMP students.”

Rome was not built in a day….

Medical education at hospitals in the north, the Island, and in communities across B.C. has also brought valuable IT infrastructure to community hospitals and clinics, and is helping health authorities attract new physicians, including graduates from UBC and other schools across Canada.

“Our job is to ensure that we are training the right number and the right kind of doctors to meet B.C.’s needs,” says Dr. David Snadden, UBC Faculty of Medicine executive associate dean, education. “We have more learners, and more diverse sites for training.

“Many factors that influence recruitment and retention are in the hands of the government and the health authorities, but we are doing our part to bring more doctors and improve access to care for underserved populations.”

There has been a significant increase in physicians practicing in rural B.C.: between 2003 and 2010, the number increased from 1,770 to 2,269, or 28 per cent.

In 2013, UBC accepted the largest number of postgraduate trainees in the history of the province, including 136 family physicians up from 51 in 2003, and added new Strathcona family medicine training site on Vancouver Island, placing residents in Courtenay, Comox, and Campbell River.

The story in numbers:

288: new undergrad med students each year, up from 126 in 2003

308: post graduate residency spots in B.C. hospitals each year, up from 163 in 2003

85: new docs who completed family practice residencies and are now practicing in B.C., 16 of them in the Northern Health Authority

2,269: the number of doctors now practising in rural B.C.—an increase of 28 per cent in the last ten years

More post-graduate residencies also attract new doctors

The expanded postgraduate residency program is also helping attract more doctors from across Canada who then choose to stay in the province.

Seventy-eight per cent (1,350) of physicians who completed their post-grad residency training at UBC between 2000 and 2011 are practicing in B.C. And of the 701 physicians who have completed family medicine training in the same period, 82 per cent (578) are practicing in communities across the province. A 2009 Canadian Institute for Health Information study found B.C. to have the third highest retention rate for MD graduates.

These numbers are expected to increase as medical undergraduate and postgraduate programs reach a steady state of expansion over the next few years.

Training the right kinds of doctors

In response to B.C.’s need for more physicians to support primary care, UBC has also increased the number of generalist trainees – in disciplines such as paediatrics, internal medicine, psychiatry, obstetrics and gynaecology. A new internal medicine residency program will open later this year in Victoria.

For Andrew Kwasnica, a 2013 Island Medical Program grad and island native, the chance to pursue his passion for internal medicine in his hometown is a dream come true.

“I have family here, and my wife’s family is from here. We have a child on the way, so it’s been important for us to put down our roots here. That’s why I wanted to stay here so badly. I’d be happy to never have to leave again.”

A third-year rotation in internal medicine exposed Kwasnica to the breadth of practice available to internists in smaller communities on the Island that lack surgeons, but still need to manage and treat sick or complex patients. For Kwasnica, learning from the community he will one day serve was ideal.

“It is imperative to understand the needs of a community, because you need to modify your practice to meet those needs and demands. You need to have awareness and interest if you are going to provide specific, personalized care for a community.”

Montgomery, who grew attached to the patients, their stories, and the natural beauty of Terrace couldn’t agree more.

“I plan to spend the next two years training to be the best doctor I can be, but also reflect on what kind of practice will work for me and the community where I will eventually settle.”

“Many factors that influence recruitment and retention are in the hands of the government and the health authorities, but we are doing our part to bring more doctors and improve access to care for underserved populations.”

In 2013, UBC accepted the largest number of postgraduate trainees in the history of the province, including 136 family physicians up from 51 in 2003, and added new Strathcona family medicine training site on Vancouver Island, placing residents in Courtenay, Comox, and Campbell River.

The story in numbers:

288: new undergrad med students each year, up from 126 in 2003

308: post graduate residency spots in B.C. hospitals each year, up from 163 in 2003

85: new docs who completed family practice residencies and are now practicing in B.C., 16 of them in the Northern Health Authority

2,269: the number of doctors now practising in rural B.C.—an increase of 28 per cent in the last ten years

Find UBC Experts

An information source that gives journalists access to UBC’s expertise.